Southwest Wilderness Outfitters, LLC
P.O. Box 1168
Pagosa Springs, Colorado  81147
Phone/Fax:  (970) 264-2655
Toll Free:  (888) 246-0970
SouthwestWildernessOutfitters.com

Please print clearly and legibly, and include all of the requested information.  This document 
is a part of our contract, therefore complete and accurate information is required.

DATE: ___/___/____

CONTACT PERSON:

Name: __________________________________________________________ Age: _______

Address (Street, Apt#, City, State & Zip Code): 
___________________________________________________________________________

Phone  Home: _______________ Alt: ________________ E-mail:________________________

How did you hear of Southwest Wilderness Outfitters, LLC? 
____________________________________ ______________________________________

Southwest Wilderness Outfitters, LLC, wants you and your party to have the safest, most enjoyable 
experience possible.  The following information will help us to ensure that happens.  HEALTH, 
MEDICAL AND DIETARY CONCERNS:  List any and all physical conditions that would affect your 
ability to hike at altitudes up to 12,500 ft.  These include any knee, foot, leg, respiratory and cardiac 
conditions.  If you have any questions or doubts, consult your physician and let him/her know about 
your expedition plans.  Also list all allergies, dietary restrictions (for any reason), current medications, 
handicaps and physical limitations. DO NOT OMIT ANYTHING THAT IS RELEVANT...this is for your 
benefit and will help ensure your comfort and enjoyment while trekking in the wilderness.

Briefly describe your hiking, camping and high altitude experience: _________________________
_____________________________________________________________________________

Please list any health, medical or dietary concerns: ______________________________________
_____________________________________________________________________________

COMPLETE THE FOLLOWING FOR EACH ADDITIONAL MEMBER OF YOUR PARTY...

Name: _____________________ Age: ____  Address: __________________________________ 
Hiking, camping and high altitude experience: __________________________________________
_____________________________________________________________________________
Health, medical or dietary concerns: _________________________________________________
_____________________________________________________________________________

Name: _____________________ Age: ____  Address: __________________________________ 
Hiking, camping and high altitude experience: __________________________________________
_____________________________________________________________________________
Health, medical or dietary concerns: _________________________________________________
_____________________________________________________________________________

Name: _____________________ Age: ____  Address: __________________________________ 
Hiking, camping and high altitude experience: __________________________________________
_____________________________________________________________________________
Health, medical or dietary concerns: _________________________________________________
_____________________________________________________________________________

Name: _____________________ Age: ____  Address: __________________________________ 
Hiking, camping and high altitude experience: __________________________________________
_____________________________________________________________________________
Health, medical or dietary concerns: _________________________________________________
_____________________________________________________________________________

Name: _____________________ Age: ____  Address: __________________________________ 
Hiking, camping and high altitude experience: __________________________________________
_____________________________________________________________________________
Health, medical or dietary concerns: _________________________________________________
_____________________________________________________________________________

Name: _____________________ Age: ____  Address: __________________________________ 
Hiking, camping and high altitude experience: __________________________________________
_____________________________________________________________________________
Health, medical or dietary concerns: _________________________________________________
_____________________________________________________________________________

TRIP LOCATION/DATES: Please choose primary and backup dates.  Must be 1 to 4 days in length...

Trip Location: __________________________________________________________________

1st Choice: ___/___/___ through ___/___/___     2nd Choice: ___/___/___ through ___/___/___

RENTAL REQUIREMENTS (Indicate number of each required):

Sleeping Bags: ______    Sleeping Pads: ______    Rain Gear: _______    Water Bottles: _______

I have read the web site and I fully understand and accept the terms and conditions and all information 
concerning physical fitness, weather, clothing, camping, altitude, safety rules and all other pertinent 
information stated therein and I know what to expect on a trip with Southwest Wilderness Outfitters, 
LLC.  I have answered all questions accurately and completely and have included all relevant information. 

SIGNATURES:

Name: _____________________ Signature ____________________________ Date: ___/___/___

Name: _____________________ Signature ____________________________ Date: ___/___/___

Name: _____________________ Signature ____________________________ Date: ___/___/___

Name: _____________________ Signature ____________________________ Date: ___/___/___

Name: _____________________ Signature ____________________________ Date: ___/___/___

Name: _____________________ Signature ____________________________ Date: ___/___/___

Name: _____________________ Signature ____________________________ Date: ___/___/___

Name: _____________________ Signature ____________________________ Date: ___/___/___

NOTE:  A PARENT OR GUARDIAN MUST SIGN FOR ALL MINORS

Southwest Wilderness Outfitters, LLC @2006, Registration Form